BACKGROUND: Evidence-based therapies that have been shown to improve outcomes in acute coronary syndromes (ACS) are often underused in clinically eligible patients. We evaluated the impact, efficacy and acceptability of a quality improvement programme to manage ACS. METHODS: A well-defined geographical area was identified and a situational analysis done. All physicians in the area, who were actively involved in the detection and management of ACS, were invited to participate in the quality improvement programme. The programme involved the use of a service delivery package which consisted of standard admission orders and patient-directed discharge instructions. Concurrently, health education in the community to promote self-detection, self-administration of aspirin and self-referral were carried out. All participating physicians were asked to register consecutive cases of ACS (20 each) presenting to their clinics before and after the intervention programme. The pre- and post-intervention data were compared. RESULTS: The use of aspirin at discharge increased from 89.7% to 96.8% (p < 0.05) and that of heparin from 57.6% to 66.3% (p < 0.05). The use of beta-blockers increased from 48.6% to 63.4% (p < 0.05) and that of lipid-lowering therapy from 74.1% to 96.3% (p < 0.05). There was a significant reduction in the use of calcium channel blockers from 21.6% to 8.1% (p < 0.05). The time to thrombolysis decreased significantly (median difference of 54 minutes, p < 0.05) after the intervention programme. CONCLUSION: Structured quality improvement programmes aimed at both patients and providers can be successful in secondary care settings of developing countries.
BACKGROUND: Evidence-based therapies that have been shown to improve outcomes in acute coronary syndromes (ACS) are often underused in clinically eligible patients. We evaluated the impact, efficacy and acceptability of a quality improvement programme to manage ACS. METHODS: A well-defined geographical area was identified and a situational analysis done. All physicians in the area, who were actively involved in the detection and management of ACS, were invited to participate in the quality improvement programme. The programme involved the use of a service delivery package which consisted of standard admission orders and patient-directed discharge instructions. Concurrently, health education in the community to promote self-detection, self-administration of aspirin and self-referral were carried out. All participating physicians were asked to register consecutive cases of ACS (20 each) presenting to their clinics before and after the intervention programme. The pre- and post-intervention data were compared. RESULTS: The use of aspirin at discharge increased from 89.7% to 96.8% (p < 0.05) and that of heparin from 57.6% to 66.3% (p < 0.05). The use of beta-blockers increased from 48.6% to 63.4% (p < 0.05) and that of lipid-lowering therapy from 74.1% to 96.3% (p < 0.05). There was a significant reduction in the use of calcium channel blockers from 21.6% to 8.1% (p < 0.05). The time to thrombolysis decreased significantly (median difference of 54 minutes, p < 0.05) after the intervention programme. CONCLUSION: Structured quality improvement programmes aimed at both patients and providers can be successful in secondary care settings of developing countries.
Authors: Santanu Guha; Rishi Sethi; Saumitra Ray; Vinay K Bahl; S Shanmugasundaram; Prafula Kerkar; Sivasubramanian Ramakrishnan; Rakesh Yadav; Gaurav Chaudhary; Aditya Kapoor; Ajay Mahajan; Ajay Kumar Sinha; Ajit Mullasari; Akshyaya Pradhan; Amal Kumar Banerjee; B P Singh; J Balachander; Brian Pinto; C N Manjunath; Chandrashekhar Makhale; Debabrata Roy; Dhiman Kahali; Geevar Zachariah; G S Wander; H C Kalita; H K Chopra; A Jabir; JagMohan Tharakan; Justin Paul; K Venogopal; K B Baksi; Kajal Ganguly; Kewal C Goswami; M Somasundaram; M K Chhetri; M S Hiremath; M S Ravi; Mrinal Kanti Das; N N Khanna; P B Jayagopal; P K Asokan; P K Deb; P P Mohanan; Praveen Chandra; Col R Girish; O Rabindra Nath; Rakesh Gupta; C Raghu; Sameer Dani; Sandeep Bansal; Sanjay Tyagi; Satyanarayan Routray; Satyendra Tewari; Sarat Chandra; Shishu Shankar Mishra; Sibananda Datta; S S Chaterjee; Soumitra Kumar; Soura Mookerjee; Suma M Victor; Sundeep Mishra; Thomas Alexander; Umesh Chandra Samal; Vijay Trehan Journal: Indian Heart J Date: 2017-03-23
Authors: Amisha Patel; Sunitha Vishwanathan; Tiny Nair; C G Bahuleyan; V L Jayaprakash; Abigail Baldridge; Mark D Huffman; Dorairaj Prabhakaran; P P Mohanan Journal: Glob Heart Date: 2015-09-26
Authors: Ehete Bahiru; Anubha Agarwal; Mark A Berendsen; Abigail S Baldridge; Tecla Temu; Amy Rogers; Carey Farquhar; Frederick Bukachi; Mark D Huffman Journal: Circ Cardiovasc Qual Outcomes Date: 2019-09-06
Authors: Kavita Singh; Raji Devarajan; Padinhare P Mohanan; Abigail S Baldridge; Dimple Kondal; David E Victorson; Kunal N Karmali; Lihui Zhao; Donald M Lloyd-Jones; Dorairaj Prabhakaran; Shifalika Goenka; Mark D Huffman Journal: Implement Sci Date: 2019-02-06 Impact factor: 7.327
Authors: Edward S Lee; Rajesh Vedanthan; Panniyammakal Jeemon; Jemima H Kamano; Preeti Kudesia; Vikram Rajan; Michael Engelgau; Andrew E Moran Journal: PLoS One Date: 2016-06-14 Impact factor: 3.240